Provider Demographics
NPI:1225494545
Name:1ST CHOICE HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:1ST CHOICE HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:CHIPPY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVACHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-905-7688
Mailing Address - Street 1:1203 BRANDT ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-3505
Mailing Address - Country:US
Mailing Address - Phone:336-763-5766
Mailing Address - Fax:336-763-5937
Practice Address - Street 1:1203 BRANDT ST STE F
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-3505
Practice Address - Country:US
Practice Address - Phone:336-763-5766
Practice Address - Fax:336-763-5937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-04
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health